Basic Information
| Provider Information | |||||||||
| NPI: | 1790013803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDON | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | RODOLFO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 BOULEVARD NE | ||||||||
| Address2: | SUITE 345 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303124205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046530039 | ||||||||
| FaxNumber: | 4046530159 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 BOULEVARD NE STE 610 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303124212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046530039 | ||||||||
| FaxNumber: | 4046530159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 008290 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.